NHIF contributors still locked out of major hospitals

Mr Simeon ole Kirgotty, NHIF chief executive officer. PHOTO | FILE 

By NEVILLE OTUKI, notuki@ke.nationmedia.com

In Summary

• The majority of hospitals are rejecting NHIF cards for outpatient treatment because they are yet to agree with the insurer on the controversial capitation levels necessary for each family.
• Major private hospitals such as Nairobi, Aga Khan and Mater have rejected the NHIF medical scheme, insisting that the capitation levels are too low.
• This is despite the fact that NHIF more than quadrupled monthly deductions beginning April last year promising more benefits, including outpatient treatment in all facilities.

Private sector workers seeking outpatient medical treatment from leading public and private hospitals are being turned away even as the National Hospital Insurance Fund (NHIF) continues to collect
higher monthly fees with the promise of expanding the range of benefits available to the contributors.

The Business Daily can report that the majority of hospitals are rejecting NHIF cards for outpatient treatment because they are yet to agree with the insurer on the controversial capitation levels necessary for each family.

This has left NHIF’s private sector members with a small number of bottom and middle-level hospitals most of which offer low quality services.

Major private hospitals such as Nairobi, Aga Khan and Mater have rejected the NHIF medical scheme, insisting that the capitation levels are too low.

Besides the top non-government hospitals, private sector workers cannot access outpatient healthcare at key public facilities such as Moi Teaching and Referral Hospital in Eldoret, Coast Provincial General Hospital (Mombasa) and Nairobi-based Kenyatta National Hospital (KNH).

This is despite the fact that NHIF more than quadrupled monthly deductions beginning April last year promising more benefits, including outpatient treatment in all facilities.

Senior hospital managers yesterday said talks were ongoing to grant private sector workers access to outpatient hospitals using NHIF cover, but did not offer any timelines.

“We are at advanced stages of discussion with NHIF before we sign the contract and roll it out,” said KNH chief executive Lily Koros.

NHIF had promised members access to medical care in private, public and faith-based hospitals such as Kiambu-based PCEA Kikuyu Hospital, which is also yet to open its doors to private sector workers for outpatient treatment.

Enquiries at the major public hospitals established that private sector workers are only eligible for the long-running inpatient care for which they can use the NHIF cover to offset part of the bed charges.

READ: NHIF to pay up to Sh5m for members treatment abroad

Civil servants are, however, enjoying both inpatient and outpatient services at selected public and private hospitals they have selected under the scheme, a situation that is brewing discontent among private sector workers.

Unlike government workers, private sector employees are also being denied access to advanced medical examination procedures like endoscopy, CT and MRI scans in public and faith-backed facilities.

Machakos Level Five Hospital, for instance, allows both public and private sector workers to access outpatient care. but private sector employees are restricted to kidney dialysis, diabetes, basic X-rays, minor surgeries and basic care for ailments like malaria and typhoid.

Officials at mission facilities like Tenwek Hospital in Bomet, gave a similar position. Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu is the only referral facility that is accepting both public and private sector workers.